Here is a beautiful quote from Mister Rogers about children and how we must redefine our mental concepts of a "whole" or "normal" child, and accept children based on who they are and not based on our own expectations.
"No child is “perfectly” whole in mind, body,
spirit, ability…nor can any child meet all of a parent’s hopes and
expectations. Yet there is a wholeness of each and every child, a wholeness
that is unique and brings with it a unique set of possibilities and
limitations, a unique set of opportunities for fulfillment."
This is a video post (click above to see the accompanying videos for this post) and quick overview of the VB -MAPP assessment tool. VB- MAPP stands for Verbal
Behavior Milestones Assessment and Placement Program, and it was developed by
Dr Sundberg, one of the creators of the ABLLS assessment tool (the newer version, the ABLLS-R, was authored by Dr. Partington).
I already have a post about the ABLLS- R, which is mainly what I have used over
the years. I am newer to the VB MAPP but I already really like it. Most ABA
professionals use the VB -MAPP or ABLLS-R assessments, so whether you are a parent or a professional it’s good to have some
knowledge of these assessment tools.
I do have some reasons why
I like the VB -MAPP over the ABLLS-R. Mainly the VB- MAPP can be MUCH quicker to
administer (how does 1 day sound?) than the ABLLS-R.
I also love the Barriers Assessment in the
VB-MAPP, and having a focus on developmental milestones because then I
can say to a parent “Your child cannot perform XYZ skill, which a typical child
would be able to do by age 18 months”. Being able to talk about age equivalents
can be very helpful for parents who may know their child is delayed, but don’t
really have a sense of the depth or severity of delay.
The VB -MAPP can be
purchased as just the protocol or you can purchase the protocol and guide
together. I would really recommend buying both, because the guide is very
helpful. This isn’t one of those assessments that you want to purchase and then
just implement. Reading the guide will help you assess more accurately, as well
as be able to discuss the results clearly and thoroughly with the family.
Assessment methods can include observation (timed or not) or direct testing.
The VB- MAPP will tell you which method to use depending on what skill you are
assessing
The focus of the VB MAPP
assessment is on Verbal Behavior and developmental milestones of typically
developing children. The assessment also covers academics, social/play, motor
skills, etc.
In my opinion, this
assessment tool is more for professionals than parents. You really need a solid
understanding of Verbal Behavior, verbal operants, and like any assessment tool,
you need an understanding of gaining instructional control and pairing with a child.
Pairing and instructional control
are hugely important when assessing anyone. As the assessor, you often are
walking into a situation where you don’t know the individual, and have to quickly
establish a good rapport so you can begin your assessment. The parents can help
greatly with this process, as they can give you information about what the
child finds reinforcing, what kind of games/toys they like, what time of day
are they best able to attend, etc. This is also why it can be so helpful to
conduct a record review, observation, and parent interview before doing the
actual assessment. I often find that the assessment is an under-representation of what the individual can do, either due to problem behaviors during assessment or the individual being uncomfortable interacting with strangers.
You should be reinforcing and fun during an
assessment, but be careful with prompting. Depending on the skill you are
assessing using the VB- MAPP prompting may be allowed, or it might not. The goal of
assessment isn’t to teach, it’s to determine the level of functioning.
So you shouldn’t be using excessive prompting. Remember: If you can’t praise the performance you can always reinforce effort (“You are
trying so hard!”)
The VB -MAPP covers 170
milestones, and has 3 main sections: Milestones assessment, Barrier assessment,
and Transitions assessment. The best plan is to complete all 3, in order to
gain a comprehensive view of current functioning level.
- The Milestones
assessment has 3 developmental levels: from 0-18 mo (Level 1), 18-30 mo, (Level
2), 30-48 mo (Level 3). Level 1 is typically a very young child, nonverbal, who
has never received treatment/intensive therapy before. The parent interview and
observation will give you a good idea of which level to start assessing on. It
will become clear pretty quickly if you need to move down a level, as the child
will be unable or unwilling to answer your questions, or participate in
activities. You could also start to see many problem behaviors (escape
behaviors) if you are starting at a level too difficult for the child. Level 2
would be an intermediate level, and it adds more domains to cover such as
Intraverbals (link). Obviously, a non verbal child doesn’t need to be assessed
on Intraverbals, so you can see how the difficulty is increasing as the levels
go up. Level 3, which would be an
advanced learner or possibly an older, higher functioning individual, covers the
most skill domains and includes more complicated skills such as academic skills
and classroom routines. This applies to all the levels but particularly for
level 3: you will likely need to observe the child in the classroom or in a
social setting to assess certain parts of the VB -MAPP. If it isn’t possible to
observe the child at school (they don’t always let ABA professionals inside)
then indicate a score of “0” since you weren’t able to assess the skill, or, you can try to gain the information you need from teacher interview.
-The Barriers assessment
is probably my favorite feature of the VB- MAPP. This tool answers the question:
What issues are present that could impede learning and/or progress? This is so
helpful as the person responsible for creating the treatment plan, and I use
this along with parent concerns to create the initial behavior plan.
During the assessment, you could see all kinds of lovely problem behaviors and
this information would go directly onto the Barriers assessment.
-The Transitions assessment
can help identify if the child is school ready, and what the ideal school
setting would be for that child. Can they attend within a group? How sociable are
they with peers? Do they exhibit challenging problem behaviors? All of this
will help determine what kind of classroom placement a child would need, and I
highly recommend sharing this information with the family and with the
teachers. For school age clients, this information can be used to help develop
the IEP.
For years I
have received emails or phone calls from parents wanting to begin ABA services
for their child, and full of more questions than answers. Even for people who
know what ABA can do, they usually don’t know how to get started. Most parents
who contact me are confused and frustrated, and still dealing with the
emotional blow of the Autism diagnosis. Some parents have told me they wish the
Autism diagnosis came with a fact sheet, or road map of what to do next. That
would be pretty difficult to do. Autism impacts each child differently, and
an Autism diagnosis is somewhat like a gemstone with many different facets and depths to it.
There is no “Autism prescription”. The treatment package will vary from one
child to the next.
Now that I
have a blog, I am so-o-o-o happy to share this information with a wider
audience. Information is only helpful when it is shared, so give the
information in this post to anyone you may know who needs ABA therapy but maybe they’ve
never heard of it, or don’t know where to start.
I'm going to
generalize a lot in this post because ABA services vary so greatly based on
location. Here is a generic guide of how to begin ABA therapy:
- The first
thing you need to do is locate the ABA providers in your area. There may be
agencies that send therapists to your home, private Autism schools, or centers
where you drop your child off for therapy. If your child is under 3 there
should be free Early Intervention services available to you, although
early intervention doesn’t always offer ABA.Contact the ABA providers to determine who has availability. It isn’t
uncommon to contact an agency and be told there is a long waiting list. This can actually be a positive, because it means the company doesn't have adequate staff to cover cases. Instead of cramming a heavy caseload on their staff, a company will start a waiting list and take the time to hire quality staff. If
there are no ABA providers in your area, I suggest starting your own in-home ABA program. Parents will often ask me where to go to find ABA therapists. There is no easy answer to that question. You may need to put up flyers on college campuses, ask other parents for recommendations, or hire non-trained individuals and pay a Consultant to train them. The average hourly rate for an independent ABA therapist is $12/hour.
-Sometimes if you get a referral or contact individuals through your insurance, the roles of ABA providers are not properly explained. Here is what I mean by that: usually an ABA Therapist and a BCBA do not perform the same tasks. Often parents contact me after getting a referral and they inquire about starting ABA therapy. I then have to explain that I provide case supervision and consultation; not direct 1:1 therapy. Which can be highly disappointing to families. Are there BCBA's who work 1:1 with clients? Sure there are. But typically, if you are new to ABA what you want are ABA direct staff first, and then once you have a team in place you want a BCBA to supervise everything and create the treatment plan.
- The next
step will be securing funding. The provider will inform you if they accept insurance,
Medicaid, have a sliding fee scale, offer scholarships, or they may even tell you about
grants available in your local area. If there are Regional Centers in your
area, they are the ones who typically pay for ABA so you should contact them
first. If the provider does accept insurance, you may have to secure the funding
before services can even start. This is because sometimes insurance companies
take months and months to approve services, so the provider may need to
determine up front that the insurance company will actually pay the claim. If you
live in an area without ABA mandated services, you will need to locate funding sources yourself, or possibly pay out of pocket for therapy.
- Now that you
have a provider and funding, you are ready to begin ABA therapy. Whether the
provider comes to your home, or you take your child to the center/school, you
(by “you” I mean all caregivers) will need to receive ABA training. For many
agencies and companies this is mandatory—families cannot begin therapy until
they have completed initial family training. If you are working with an
independent contractor (they work for themselves, not an agency) then I highly
recommend you request initial training from that person. If the independent
contractor is not qualified to conduct trainings, you may need to receive
training separately. It will be very important that the family learn how to
apply the fundamental techniques of ABA. In order to see the most benefit from
the ABA therapy, the family must reinforce what the therapists are teaching.
This will be very hard to do without ongoing caregiver training.
- Lastly, what
is most important about beginning ABA therapy is understanding that ABA is a lifestyle
change and a commitment. It isn’t something you “kinda sorta” do. You will likely have a team of professionals coming in and out of your home several times each week, and it can be annoying, frustrating, invasive to your privacy, and overwhelming. Its also important to remember: Autism doesn’t take a day off, so ABA shouldn’t take a day off.
ABA therapy shouldn’t stop because the family moves to a new home, the ABA
therapist is sick, the grandparents are visiting for Thanksgiving, or because
school starts. When the ABA providers are not working 1:1 with your child, then
guess who is now the acting ABA therapist? That’s right, you are.
ABA is a
commitment to a lifestyle change, and I can quite honestly say that parents who
don’t understand or agree with that commitment do not see the progress they are
expecting to see from ABA therapy.
**Quick Tip:
For those of you still on the fence about if ABA therapy is necessary for your
child, I suggest reading my “What is ABA?” post.
Awesome Resource: "A Parent's Guide - Before Starting ABA Therapy" This 31 page eBook helps parents learn what they can do, right NOW, to help their child learn and improve while waiting on therapy services to begin.
